|
HC IMPL GRAFT EPIFIX 3X4 CM
|
Facility
|
OP
|
$223.00
|
|
|
Service Code
|
CPT Q4186
|
| Hospital Charge Code |
900101527
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.60 |
| Max. Negotiated Rate |
$981.22 |
| Rate for Payer: Adventist Health Commercial |
$44.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$160.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$981.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$160.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$107.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$129.72
|
| Rate for Payer: Blue Shield of California Commercial |
$141.38
|
| Rate for Payer: Blue Shield of California EPN |
$88.98
|
| Rate for Payer: Cash Price |
$100.35
|
| Rate for Payer: Cash Price |
$100.35
|
| Rate for Payer: Central Health Plan Commercial |
$178.40
|
| Rate for Payer: Cigna of CA HMO |
$156.10
|
| Rate for Payer: Cigna of CA PPO |
$156.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$240.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$160.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$156.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$264.10
|
| Rate for Payer: EPIC Health Plan Senior |
$176.07
|
| Rate for Payer: Galaxy Health WC |
$189.55
|
| Rate for Payer: Global Benefits Group Commercial |
$133.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$200.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$262.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$260.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$141.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$288.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$224.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$167.25
|
| Rate for Payer: Networks By Design Commercial |
$111.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$160.06
|
| Rate for Payer: Prime Health Services Commercial |
$189.55
|
| Rate for Payer: Prime Health Services Medicare |
$169.66
|
| Rate for Payer: Riverside University Health System MISP |
$176.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$133.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$133.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$83.69
|
| Rate for Payer: United Healthcare All Other HMO |
$81.46
|
| Rate for Payer: United Healthcare HMO Rider |
$79.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$73.03
|
| Rate for Payer: Upland Medical Group Pediatric |
$160.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Vantage Medical Group Senior |
$160.06
|
|
|
HC IMPL GRAFT EPIFIX 4X4.5 CM MESH
|
Facility
|
OP
|
$212.00
|
|
|
Service Code
|
CPT Q4186
|
| Hospital Charge Code |
900101528
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.40 |
| Max. Negotiated Rate |
$981.22 |
| Rate for Payer: Adventist Health Commercial |
$42.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$160.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$981.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$160.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$102.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$123.32
|
| Rate for Payer: Blue Shield of California Commercial |
$134.41
|
| Rate for Payer: Blue Shield of California EPN |
$84.59
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Central Health Plan Commercial |
$169.60
|
| Rate for Payer: Cigna of CA HMO |
$148.40
|
| Rate for Payer: Cigna of CA PPO |
$148.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$240.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$160.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$148.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$264.10
|
| Rate for Payer: EPIC Health Plan Senior |
$176.07
|
| Rate for Payer: Galaxy Health WC |
$180.20
|
| Rate for Payer: Global Benefits Group Commercial |
$127.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$190.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$262.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$260.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$134.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$288.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$224.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$159.00
|
| Rate for Payer: Networks By Design Commercial |
$106.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$160.06
|
| Rate for Payer: Prime Health Services Commercial |
$180.20
|
| Rate for Payer: Prime Health Services Medicare |
$169.66
|
| Rate for Payer: Riverside University Health System MISP |
$176.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$127.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$127.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$79.56
|
| Rate for Payer: United Healthcare All Other HMO |
$77.44
|
| Rate for Payer: United Healthcare HMO Rider |
$75.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$69.43
|
| Rate for Payer: Upland Medical Group Pediatric |
$160.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Vantage Medical Group Senior |
$160.06
|
|
|
HC IMPL GRAFT EPIFIX 4X4.5 CM MESH
|
Facility
|
IP
|
$212.00
|
|
|
Service Code
|
CPT Q4186
|
| Hospital Charge Code |
900101528
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.40 |
| Max. Negotiated Rate |
$190.80 |
| Rate for Payer: Adventist Health Commercial |
$42.40
|
| Rate for Payer: Blue Shield of California Commercial |
$170.02
|
| Rate for Payer: Blue Shield of California EPN |
$106.85
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Central Health Plan Commercial |
$169.60
|
| Rate for Payer: Cigna of CA HMO |
$148.40
|
| Rate for Payer: Cigna of CA PPO |
$148.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$148.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.80
|
| Rate for Payer: EPIC Health Plan Senior |
$84.80
|
| Rate for Payer: Galaxy Health WC |
$180.20
|
| Rate for Payer: Global Benefits Group Commercial |
$127.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$190.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$134.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$125.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.40
|
| Rate for Payer: Multiplan Commercial |
$159.00
|
| Rate for Payer: Networks By Design Commercial |
$106.00
|
| Rate for Payer: Prime Health Services Commercial |
$180.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$79.56
|
| Rate for Payer: United Healthcare All Other HMO |
$77.44
|
| Rate for Payer: United Healthcare HMO Rider |
$75.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$69.43
|
|
|
HC IMPL GRAFT EPIFIX 4X4 CM
|
Facility
|
OP
|
$244.00
|
|
|
Service Code
|
CPT Q4186
|
| Hospital Charge Code |
900101530
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$48.80 |
| Max. Negotiated Rate |
$981.22 |
| Rate for Payer: Adventist Health Commercial |
$48.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$160.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$981.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$160.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$118.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$141.93
|
| Rate for Payer: Blue Shield of California Commercial |
$154.70
|
| Rate for Payer: Blue Shield of California EPN |
$97.36
|
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Central Health Plan Commercial |
$195.20
|
| Rate for Payer: Cigna of CA HMO |
$170.80
|
| Rate for Payer: Cigna of CA PPO |
$170.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$240.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$160.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$170.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$264.10
|
| Rate for Payer: EPIC Health Plan Senior |
$176.07
|
| Rate for Payer: Galaxy Health WC |
$207.40
|
| Rate for Payer: Global Benefits Group Commercial |
$146.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$219.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$262.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$260.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$154.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$288.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$224.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$183.00
|
| Rate for Payer: Networks By Design Commercial |
$122.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$160.06
|
| Rate for Payer: Prime Health Services Commercial |
$207.40
|
| Rate for Payer: Prime Health Services Medicare |
$169.66
|
| Rate for Payer: Riverside University Health System MISP |
$176.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$146.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$146.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$91.57
|
| Rate for Payer: United Healthcare All Other HMO |
$89.13
|
| Rate for Payer: United Healthcare HMO Rider |
$87.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$79.91
|
| Rate for Payer: Upland Medical Group Pediatric |
$160.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Vantage Medical Group Senior |
$160.06
|
|
|
HC IMPL GRAFT EPIFIX 4X4 CM
|
Facility
|
IP
|
$244.00
|
|
|
Service Code
|
CPT Q4186
|
| Hospital Charge Code |
900101530
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$48.80 |
| Max. Negotiated Rate |
$219.60 |
| Rate for Payer: Adventist Health Commercial |
$48.80
|
| Rate for Payer: Blue Shield of California Commercial |
$195.69
|
| Rate for Payer: Blue Shield of California EPN |
$122.98
|
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Central Health Plan Commercial |
$195.20
|
| Rate for Payer: Cigna of CA HMO |
$170.80
|
| Rate for Payer: Cigna of CA PPO |
$170.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$170.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.60
|
| Rate for Payer: EPIC Health Plan Senior |
$97.60
|
| Rate for Payer: Galaxy Health WC |
$207.40
|
| Rate for Payer: Global Benefits Group Commercial |
$146.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$219.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$154.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$143.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.80
|
| Rate for Payer: Multiplan Commercial |
$183.00
|
| Rate for Payer: Networks By Design Commercial |
$122.00
|
| Rate for Payer: Prime Health Services Commercial |
$207.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$91.57
|
| Rate for Payer: United Healthcare All Other HMO |
$89.13
|
| Rate for Payer: United Healthcare HMO Rider |
$87.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$79.91
|
|
|
HC IMPL GRAFT EPIFIX 5X6 CM
|
Facility
|
OP
|
$223.00
|
|
|
Service Code
|
CPT Q4186
|
| Hospital Charge Code |
900101531
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.60 |
| Max. Negotiated Rate |
$981.22 |
| Rate for Payer: Adventist Health Commercial |
$44.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$160.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$981.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$160.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$107.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$129.72
|
| Rate for Payer: Blue Shield of California Commercial |
$141.38
|
| Rate for Payer: Blue Shield of California EPN |
$88.98
|
| Rate for Payer: Cash Price |
$100.35
|
| Rate for Payer: Cash Price |
$100.35
|
| Rate for Payer: Central Health Plan Commercial |
$178.40
|
| Rate for Payer: Cigna of CA HMO |
$156.10
|
| Rate for Payer: Cigna of CA PPO |
$156.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$240.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$160.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$156.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$264.10
|
| Rate for Payer: EPIC Health Plan Senior |
$176.07
|
| Rate for Payer: Galaxy Health WC |
$189.55
|
| Rate for Payer: Global Benefits Group Commercial |
$133.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$200.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$262.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$260.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$141.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$288.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$224.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$167.25
|
| Rate for Payer: Networks By Design Commercial |
$111.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$160.06
|
| Rate for Payer: Prime Health Services Commercial |
$189.55
|
| Rate for Payer: Prime Health Services Medicare |
$169.66
|
| Rate for Payer: Riverside University Health System MISP |
$176.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$133.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$133.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$83.69
|
| Rate for Payer: United Healthcare All Other HMO |
$81.46
|
| Rate for Payer: United Healthcare HMO Rider |
$79.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$73.03
|
| Rate for Payer: Upland Medical Group Pediatric |
$160.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Vantage Medical Group Senior |
$160.06
|
|
|
HC IMPL GRAFT EPIFIX 5X6 CM
|
Facility
|
IP
|
$223.00
|
|
|
Service Code
|
CPT Q4186
|
| Hospital Charge Code |
900101531
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.60 |
| Max. Negotiated Rate |
$200.70 |
| Rate for Payer: Adventist Health Commercial |
$44.60
|
| Rate for Payer: Blue Shield of California Commercial |
$178.85
|
| Rate for Payer: Blue Shield of California EPN |
$112.39
|
| Rate for Payer: Cash Price |
$100.35
|
| Rate for Payer: Central Health Plan Commercial |
$178.40
|
| Rate for Payer: Cigna of CA HMO |
$156.10
|
| Rate for Payer: Cigna of CA PPO |
$156.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$156.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.20
|
| Rate for Payer: EPIC Health Plan Senior |
$89.20
|
| Rate for Payer: Galaxy Health WC |
$189.55
|
| Rate for Payer: Global Benefits Group Commercial |
$133.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$200.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$141.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$131.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.60
|
| Rate for Payer: Multiplan Commercial |
$167.25
|
| Rate for Payer: Networks By Design Commercial |
$111.50
|
| Rate for Payer: Prime Health Services Commercial |
$189.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$83.69
|
| Rate for Payer: United Healthcare All Other HMO |
$81.46
|
| Rate for Payer: United Healthcare HMO Rider |
$79.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$73.03
|
|
|
HC IMPL PRIMATRIX 4CM X 4CM MESH
|
Facility
|
OP
|
$189.00
|
|
|
Service Code
|
CPT Q4110
|
| Hospital Charge Code |
900101517
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$405.32 |
| Rate for Payer: Adventist Health Commercial |
$37.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$160.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$405.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$160.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$69.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$86.44
|
| Rate for Payer: Blue Shield of California Commercial |
$119.83
|
| Rate for Payer: Blue Shield of California EPN |
$75.41
|
| Rate for Payer: Cash Price |
$85.05
|
| Rate for Payer: Cash Price |
$85.05
|
| Rate for Payer: Central Health Plan Commercial |
$151.20
|
| Rate for Payer: Cigna of CA HMO |
$132.30
|
| Rate for Payer: Cigna of CA PPO |
$132.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$240.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$160.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$132.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$264.10
|
| Rate for Payer: EPIC Health Plan Senior |
$176.07
|
| Rate for Payer: Galaxy Health WC |
$160.65
|
| Rate for Payer: Global Benefits Group Commercial |
$113.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$170.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$262.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$67.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$120.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$74.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$224.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$141.75
|
| Rate for Payer: Networks By Design Commercial |
$94.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$160.06
|
| Rate for Payer: Prime Health Services Commercial |
$160.65
|
| Rate for Payer: Prime Health Services Medicare |
$169.66
|
| Rate for Payer: Riverside University Health System MISP |
$176.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$113.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$113.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$70.93
|
| Rate for Payer: United Healthcare All Other HMO |
$69.04
|
| Rate for Payer: United Healthcare HMO Rider |
$67.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$61.90
|
| Rate for Payer: Upland Medical Group Pediatric |
$160.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Vantage Medical Group Senior |
$160.06
|
|
|
HC IMPL PRIMATRIX 4CM X 4CM MESH
|
Facility
|
IP
|
$189.00
|
|
|
Service Code
|
CPT Q4110
|
| Hospital Charge Code |
900101517
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$170.10 |
| Rate for Payer: Adventist Health Commercial |
$37.80
|
| Rate for Payer: Blue Shield of California Commercial |
$151.58
|
| Rate for Payer: Blue Shield of California EPN |
$95.26
|
| Rate for Payer: Cash Price |
$85.05
|
| Rate for Payer: Central Health Plan Commercial |
$151.20
|
| Rate for Payer: Cigna of CA HMO |
$132.30
|
| Rate for Payer: Cigna of CA PPO |
$132.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$132.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.60
|
| Rate for Payer: EPIC Health Plan Senior |
$75.60
|
| Rate for Payer: Galaxy Health WC |
$160.65
|
| Rate for Payer: Global Benefits Group Commercial |
$113.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$170.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$120.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$111.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.80
|
| Rate for Payer: Multiplan Commercial |
$141.75
|
| Rate for Payer: Networks By Design Commercial |
$94.50
|
| Rate for Payer: Prime Health Services Commercial |
$160.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$70.93
|
| Rate for Payer: United Healthcare All Other HMO |
$69.04
|
| Rate for Payer: United Healthcare HMO Rider |
$67.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$61.90
|
|
|
HC IMPL PRIMATRIX 5CM X 5CM MESH
|
Facility
|
OP
|
$183.00
|
|
|
Service Code
|
CPT Q4110
|
| Hospital Charge Code |
900101518
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.60 |
| Max. Negotiated Rate |
$405.32 |
| Rate for Payer: Adventist Health Commercial |
$36.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$160.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$405.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$160.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$69.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$86.44
|
| Rate for Payer: Blue Shield of California Commercial |
$116.02
|
| Rate for Payer: Blue Shield of California EPN |
$73.02
|
| Rate for Payer: Cash Price |
$82.35
|
| Rate for Payer: Cash Price |
$82.35
|
| Rate for Payer: Central Health Plan Commercial |
$146.40
|
| Rate for Payer: Cigna of CA HMO |
$128.10
|
| Rate for Payer: Cigna of CA PPO |
$128.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$240.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$160.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$128.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$264.10
|
| Rate for Payer: EPIC Health Plan Senior |
$176.07
|
| Rate for Payer: Galaxy Health WC |
$155.55
|
| Rate for Payer: Global Benefits Group Commercial |
$109.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$164.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$262.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$67.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$116.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$74.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$224.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$137.25
|
| Rate for Payer: Networks By Design Commercial |
$91.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$160.06
|
| Rate for Payer: Prime Health Services Commercial |
$155.55
|
| Rate for Payer: Prime Health Services Medicare |
$169.66
|
| Rate for Payer: Riverside University Health System MISP |
$176.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$109.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$109.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$68.68
|
| Rate for Payer: United Healthcare All Other HMO |
$66.85
|
| Rate for Payer: United Healthcare HMO Rider |
$65.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.93
|
| Rate for Payer: Upland Medical Group Pediatric |
$160.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Vantage Medical Group Senior |
$160.06
|
|
|
HC IMPL PRIMATRIX 5CM X 5CM MESH
|
Facility
|
IP
|
$183.00
|
|
|
Service Code
|
CPT Q4110
|
| Hospital Charge Code |
900101518
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.60 |
| Max. Negotiated Rate |
$164.70 |
| Rate for Payer: Adventist Health Commercial |
$36.60
|
| Rate for Payer: Blue Shield of California Commercial |
$146.77
|
| Rate for Payer: Blue Shield of California EPN |
$92.23
|
| Rate for Payer: Cash Price |
$82.35
|
| Rate for Payer: Central Health Plan Commercial |
$146.40
|
| Rate for Payer: Cigna of CA HMO |
$128.10
|
| Rate for Payer: Cigna of CA PPO |
$128.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$128.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.20
|
| Rate for Payer: EPIC Health Plan Senior |
$73.20
|
| Rate for Payer: Galaxy Health WC |
$155.55
|
| Rate for Payer: Global Benefits Group Commercial |
$109.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$164.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$116.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$107.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.60
|
| Rate for Payer: Multiplan Commercial |
$137.25
|
| Rate for Payer: Networks By Design Commercial |
$91.50
|
| Rate for Payer: Prime Health Services Commercial |
$155.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$68.68
|
| Rate for Payer: United Healthcare All Other HMO |
$66.85
|
| Rate for Payer: United Healthcare HMO Rider |
$65.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.93
|
|
|
HC IMPL PRIMATRIX 6CM X 6CM FENESTRATED
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
CPT Q4110
|
| Hospital Charge Code |
900101519
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$405.32 |
| Rate for Payer: Adventist Health Commercial |
$25.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$160.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$405.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$160.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$69.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$86.44
|
| Rate for Payer: Blue Shield of California Commercial |
$79.88
|
| Rate for Payer: Blue Shield of California EPN |
$50.27
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Central Health Plan Commercial |
$100.80
|
| Rate for Payer: Cigna of CA HMO |
$88.20
|
| Rate for Payer: Cigna of CA PPO |
$88.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$240.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$160.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$88.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$264.10
|
| Rate for Payer: EPIC Health Plan Senior |
$176.07
|
| Rate for Payer: Galaxy Health WC |
$107.10
|
| Rate for Payer: Global Benefits Group Commercial |
$75.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$113.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$262.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$67.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$80.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$74.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$224.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$94.50
|
| Rate for Payer: Networks By Design Commercial |
$63.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$160.06
|
| Rate for Payer: Prime Health Services Commercial |
$107.10
|
| Rate for Payer: Prime Health Services Medicare |
$169.66
|
| Rate for Payer: Riverside University Health System MISP |
$176.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$75.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$47.29
|
| Rate for Payer: United Healthcare All Other HMO |
$46.03
|
| Rate for Payer: United Healthcare HMO Rider |
$45.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.27
|
| Rate for Payer: Upland Medical Group Pediatric |
$160.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Vantage Medical Group Senior |
$160.06
|
|
|
HC IMPL PRIMATRIX 6CM X 6CM FENESTRATED
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
CPT Q4110
|
| Hospital Charge Code |
900101519
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$113.40 |
| Rate for Payer: Adventist Health Commercial |
$25.20
|
| Rate for Payer: Blue Shield of California Commercial |
$101.05
|
| Rate for Payer: Blue Shield of California EPN |
$63.50
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Central Health Plan Commercial |
$100.80
|
| Rate for Payer: Cigna of CA HMO |
$88.20
|
| Rate for Payer: Cigna of CA PPO |
$88.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$88.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.40
|
| Rate for Payer: EPIC Health Plan Senior |
$50.40
|
| Rate for Payer: Galaxy Health WC |
$107.10
|
| Rate for Payer: Global Benefits Group Commercial |
$75.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$113.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$80.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$74.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.20
|
| Rate for Payer: Multiplan Commercial |
$94.50
|
| Rate for Payer: Networks By Design Commercial |
$63.00
|
| Rate for Payer: Prime Health Services Commercial |
$107.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$47.29
|
| Rate for Payer: United Healthcare All Other HMO |
$46.03
|
| Rate for Payer: United Healthcare HMO Rider |
$45.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.27
|
|
|
HC IMPL PRIMATRIX 6CM X 6CM MESH
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
CPT Q4110
|
| Hospital Charge Code |
900101520
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$113.40 |
| Rate for Payer: Adventist Health Commercial |
$25.20
|
| Rate for Payer: Blue Shield of California Commercial |
$101.05
|
| Rate for Payer: Blue Shield of California EPN |
$63.50
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Central Health Plan Commercial |
$100.80
|
| Rate for Payer: Cigna of CA HMO |
$88.20
|
| Rate for Payer: Cigna of CA PPO |
$88.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$88.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.40
|
| Rate for Payer: EPIC Health Plan Senior |
$50.40
|
| Rate for Payer: Galaxy Health WC |
$107.10
|
| Rate for Payer: Global Benefits Group Commercial |
$75.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$113.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$80.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$74.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.20
|
| Rate for Payer: Multiplan Commercial |
$94.50
|
| Rate for Payer: Networks By Design Commercial |
$63.00
|
| Rate for Payer: Prime Health Services Commercial |
$107.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$47.29
|
| Rate for Payer: United Healthcare All Other HMO |
$46.03
|
| Rate for Payer: United Healthcare HMO Rider |
$45.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.27
|
|
|
HC IMPL PRIMATRIX 6CM X 6CM MESH
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
CPT Q4110
|
| Hospital Charge Code |
900101520
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$405.32 |
| Rate for Payer: Adventist Health Commercial |
$25.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$160.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$405.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$160.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$69.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$86.44
|
| Rate for Payer: Blue Shield of California Commercial |
$79.88
|
| Rate for Payer: Blue Shield of California EPN |
$50.27
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Central Health Plan Commercial |
$100.80
|
| Rate for Payer: Cigna of CA HMO |
$88.20
|
| Rate for Payer: Cigna of CA PPO |
$88.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$240.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$160.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$88.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$264.10
|
| Rate for Payer: EPIC Health Plan Senior |
$176.07
|
| Rate for Payer: Galaxy Health WC |
$107.10
|
| Rate for Payer: Global Benefits Group Commercial |
$75.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$113.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$262.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$67.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$80.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$74.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$224.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$94.50
|
| Rate for Payer: Networks By Design Commercial |
$63.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$160.06
|
| Rate for Payer: Prime Health Services Commercial |
$107.10
|
| Rate for Payer: Prime Health Services Medicare |
$169.66
|
| Rate for Payer: Riverside University Health System MISP |
$176.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$75.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$47.29
|
| Rate for Payer: United Healthcare All Other HMO |
$46.03
|
| Rate for Payer: United Healthcare HMO Rider |
$45.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.27
|
| Rate for Payer: Upland Medical Group Pediatric |
$160.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Vantage Medical Group Senior |
$160.06
|
|
|
HC IMPL PRIMATRIX AG 4CM X 4CM FENESTRATED
|
Facility
|
OP
|
$189.00
|
|
|
Service Code
|
CPT Q4110
|
| Hospital Charge Code |
900101521
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$405.32 |
| Rate for Payer: Adventist Health Commercial |
$37.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$160.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$405.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$160.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$69.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$86.44
|
| Rate for Payer: Blue Shield of California Commercial |
$119.83
|
| Rate for Payer: Blue Shield of California EPN |
$75.41
|
| Rate for Payer: Cash Price |
$85.05
|
| Rate for Payer: Cash Price |
$85.05
|
| Rate for Payer: Central Health Plan Commercial |
$151.20
|
| Rate for Payer: Cigna of CA HMO |
$132.30
|
| Rate for Payer: Cigna of CA PPO |
$132.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$240.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$160.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$132.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$264.10
|
| Rate for Payer: EPIC Health Plan Senior |
$176.07
|
| Rate for Payer: Galaxy Health WC |
$160.65
|
| Rate for Payer: Global Benefits Group Commercial |
$113.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$170.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$262.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$67.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$120.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$74.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$224.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$141.75
|
| Rate for Payer: Networks By Design Commercial |
$94.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$160.06
|
| Rate for Payer: Prime Health Services Commercial |
$160.65
|
| Rate for Payer: Prime Health Services Medicare |
$169.66
|
| Rate for Payer: Riverside University Health System MISP |
$176.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$113.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$113.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$70.93
|
| Rate for Payer: United Healthcare All Other HMO |
$69.04
|
| Rate for Payer: United Healthcare HMO Rider |
$67.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$61.90
|
| Rate for Payer: Upland Medical Group Pediatric |
$160.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Vantage Medical Group Senior |
$160.06
|
|
|
HC IMPL PRIMATRIX AG 4CM X 4CM FENESTRATED
|
Facility
|
IP
|
$189.00
|
|
|
Service Code
|
CPT Q4110
|
| Hospital Charge Code |
900101521
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$170.10 |
| Rate for Payer: Adventist Health Commercial |
$37.80
|
| Rate for Payer: Blue Shield of California Commercial |
$151.58
|
| Rate for Payer: Blue Shield of California EPN |
$95.26
|
| Rate for Payer: Cash Price |
$85.05
|
| Rate for Payer: Central Health Plan Commercial |
$151.20
|
| Rate for Payer: Cigna of CA HMO |
$132.30
|
| Rate for Payer: Cigna of CA PPO |
$132.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$132.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.60
|
| Rate for Payer: EPIC Health Plan Senior |
$75.60
|
| Rate for Payer: Galaxy Health WC |
$160.65
|
| Rate for Payer: Global Benefits Group Commercial |
$113.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$170.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$120.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$111.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.80
|
| Rate for Payer: Multiplan Commercial |
$141.75
|
| Rate for Payer: Networks By Design Commercial |
$94.50
|
| Rate for Payer: Prime Health Services Commercial |
$160.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$70.93
|
| Rate for Payer: United Healthcare All Other HMO |
$69.04
|
| Rate for Payer: United Healthcare HMO Rider |
$67.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$61.90
|
|
|
HC IMPL PRIMATRIX AG 4CM X 4CM MESH
|
Facility
|
OP
|
$189.00
|
|
|
Service Code
|
CPT Q4110
|
| Hospital Charge Code |
900101522
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$405.32 |
| Rate for Payer: Adventist Health Commercial |
$37.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$160.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$405.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$160.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$69.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$86.44
|
| Rate for Payer: Blue Shield of California Commercial |
$119.83
|
| Rate for Payer: Blue Shield of California EPN |
$75.41
|
| Rate for Payer: Cash Price |
$85.05
|
| Rate for Payer: Cash Price |
$85.05
|
| Rate for Payer: Central Health Plan Commercial |
$151.20
|
| Rate for Payer: Cigna of CA HMO |
$132.30
|
| Rate for Payer: Cigna of CA PPO |
$132.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$240.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$160.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$132.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$264.10
|
| Rate for Payer: EPIC Health Plan Senior |
$176.07
|
| Rate for Payer: Galaxy Health WC |
$160.65
|
| Rate for Payer: Global Benefits Group Commercial |
$113.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$170.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$262.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$67.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$120.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$74.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$224.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$141.75
|
| Rate for Payer: Networks By Design Commercial |
$94.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$160.06
|
| Rate for Payer: Prime Health Services Commercial |
$160.65
|
| Rate for Payer: Prime Health Services Medicare |
$169.66
|
| Rate for Payer: Riverside University Health System MISP |
$176.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$113.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$113.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$70.93
|
| Rate for Payer: United Healthcare All Other HMO |
$69.04
|
| Rate for Payer: United Healthcare HMO Rider |
$67.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$61.90
|
| Rate for Payer: Upland Medical Group Pediatric |
$160.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Vantage Medical Group Senior |
$160.06
|
|
|
HC IMPL PRIMATRIX AG 4CM X 4CM MESH
|
Facility
|
IP
|
$189.00
|
|
|
Service Code
|
CPT Q4110
|
| Hospital Charge Code |
900101522
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$170.10 |
| Rate for Payer: Adventist Health Commercial |
$37.80
|
| Rate for Payer: Blue Shield of California Commercial |
$151.58
|
| Rate for Payer: Blue Shield of California EPN |
$95.26
|
| Rate for Payer: Cash Price |
$85.05
|
| Rate for Payer: Central Health Plan Commercial |
$151.20
|
| Rate for Payer: Cigna of CA HMO |
$132.30
|
| Rate for Payer: Cigna of CA PPO |
$132.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$132.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.60
|
| Rate for Payer: EPIC Health Plan Senior |
$75.60
|
| Rate for Payer: Galaxy Health WC |
$160.65
|
| Rate for Payer: Global Benefits Group Commercial |
$113.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$170.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$120.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$111.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.80
|
| Rate for Payer: Multiplan Commercial |
$141.75
|
| Rate for Payer: Networks By Design Commercial |
$94.50
|
| Rate for Payer: Prime Health Services Commercial |
$160.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$70.93
|
| Rate for Payer: United Healthcare All Other HMO |
$69.04
|
| Rate for Payer: United Healthcare HMO Rider |
$67.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$61.90
|
|
|
HC IMPL PRIMATRIX AG 6CM X 6CM FENESTRATED
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
CPT Q4110
|
| Hospital Charge Code |
900101523
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.60 |
| Max. Negotiated Rate |
$405.32 |
| Rate for Payer: Adventist Health Commercial |
$26.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$160.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$405.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$160.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$69.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$86.44
|
| Rate for Payer: Blue Shield of California Commercial |
$84.32
|
| Rate for Payer: Blue Shield of California EPN |
$53.07
|
| Rate for Payer: Cash Price |
$59.85
|
| Rate for Payer: Cash Price |
$59.85
|
| Rate for Payer: Central Health Plan Commercial |
$106.40
|
| Rate for Payer: Cigna of CA HMO |
$93.10
|
| Rate for Payer: Cigna of CA PPO |
$93.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$240.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$160.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$93.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$264.10
|
| Rate for Payer: EPIC Health Plan Senior |
$176.07
|
| Rate for Payer: Galaxy Health WC |
$113.05
|
| Rate for Payer: Global Benefits Group Commercial |
$79.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$119.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$262.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$67.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$84.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$74.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$224.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$99.75
|
| Rate for Payer: Networks By Design Commercial |
$66.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$160.06
|
| Rate for Payer: Prime Health Services Commercial |
$113.05
|
| Rate for Payer: Prime Health Services Medicare |
$169.66
|
| Rate for Payer: Riverside University Health System MISP |
$176.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$79.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$79.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.91
|
| Rate for Payer: United Healthcare All Other HMO |
$48.58
|
| Rate for Payer: United Healthcare HMO Rider |
$47.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$160.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Vantage Medical Group Senior |
$160.06
|
|
|
HC IMPL PRIMATRIX AG 6CM X 6CM FENESTRATED
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
CPT Q4110
|
| Hospital Charge Code |
900101523
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.60 |
| Max. Negotiated Rate |
$119.70 |
| Rate for Payer: Adventist Health Commercial |
$26.60
|
| Rate for Payer: Blue Shield of California Commercial |
$106.67
|
| Rate for Payer: Blue Shield of California EPN |
$67.03
|
| Rate for Payer: Cash Price |
$59.85
|
| Rate for Payer: Central Health Plan Commercial |
$106.40
|
| Rate for Payer: Cigna of CA HMO |
$93.10
|
| Rate for Payer: Cigna of CA PPO |
$93.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$93.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.20
|
| Rate for Payer: EPIC Health Plan Senior |
$53.20
|
| Rate for Payer: Galaxy Health WC |
$113.05
|
| Rate for Payer: Global Benefits Group Commercial |
$79.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$119.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$84.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$78.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.60
|
| Rate for Payer: Multiplan Commercial |
$99.75
|
| Rate for Payer: Networks By Design Commercial |
$66.50
|
| Rate for Payer: Prime Health Services Commercial |
$113.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.91
|
| Rate for Payer: United Healthcare All Other HMO |
$48.58
|
| Rate for Payer: United Healthcare HMO Rider |
$47.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.56
|
|
|
HC IMPL SJM CONFIRM LOOPRE DM3500
|
Facility
|
OP
|
$11,500.00
|
|
|
Service Code
|
CPT C1764
|
| Hospital Charge Code |
906813826
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,300.00 |
| Max. Negotiated Rate |
$10,350.00 |
| Rate for Payer: Adventist Health Commercial |
$2,300.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,775.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,325.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,625.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,250.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,306.60
|
| Rate for Payer: Blue Shield of California Commercial |
$9,223.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,796.00
|
| Rate for Payer: Cash Price |
$5,175.00
|
| Rate for Payer: Central Health Plan Commercial |
$9,200.00
|
| Rate for Payer: Cigna of CA HMO |
$8,050.00
|
| Rate for Payer: Cigna of CA PPO |
$8,050.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,775.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,775.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,775.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,050.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,600.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,600.00
|
| Rate for Payer: Galaxy Health WC |
$9,775.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,900.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,350.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,302.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,174.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,785.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,300.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8,050.00
|
| Rate for Payer: Multiplan Commercial |
$8,625.00
|
| Rate for Payer: Networks By Design Commercial |
$5,750.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,775.00
|
| Rate for Payer: Riverside University Health System MISP |
$4,600.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,900.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,900.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,315.95
|
| Rate for Payer: United Healthcare All Other HMO |
$4,200.95
|
| Rate for Payer: United Healthcare HMO Rider |
$4,110.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,766.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,775.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,775.00
|
| Rate for Payer: Vantage Medical Group Senior |
$9,775.00
|
|
|
HC IMPL SJM CONFIRM LOOPRE DM3500
|
Facility
|
IP
|
$11,500.00
|
|
|
Service Code
|
CPT C1764
|
| Hospital Charge Code |
906813826
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,300.00 |
| Max. Negotiated Rate |
$10,350.00 |
| Rate for Payer: Adventist Health Commercial |
$2,300.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,223.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,796.00
|
| Rate for Payer: Cash Price |
$5,175.00
|
| Rate for Payer: Central Health Plan Commercial |
$9,200.00
|
| Rate for Payer: Cigna of CA HMO |
$8,050.00
|
| Rate for Payer: Cigna of CA PPO |
$8,050.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,050.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,600.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,600.00
|
| Rate for Payer: Galaxy Health WC |
$9,775.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,900.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,350.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,302.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,785.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,300.00
|
| Rate for Payer: Multiplan Commercial |
$8,625.00
|
| Rate for Payer: Networks By Design Commercial |
$5,750.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,775.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,315.95
|
| Rate for Payer: United Healthcare All Other HMO |
$4,200.95
|
| Rate for Payer: United Healthcare HMO Rider |
$4,110.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,766.25
|
|
|
HC IMPL SPINAL CANAL CATH
|
Facility
|
IP
|
$22,359.00
|
|
|
Service Code
|
CPT 62350
|
| Hospital Charge Code |
900100865
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,471.80 |
| Max. Negotiated Rate |
$20,123.10 |
| Rate for Payer: Adventist Health Commercial |
$4,471.80
|
| Rate for Payer: Cash Price |
$10,061.55
|
| Rate for Payer: Central Health Plan Commercial |
$17,887.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15,651.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,943.60
|
| Rate for Payer: EPIC Health Plan Senior |
$8,943.60
|
| Rate for Payer: Galaxy Health WC |
$19,005.15
|
| Rate for Payer: Global Benefits Group Commercial |
$13,415.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$20,123.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14,197.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13,191.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,471.80
|
| Rate for Payer: Multiplan Commercial |
$16,769.25
|
| Rate for Payer: Networks By Design Commercial |
$14,533.35
|
| Rate for Payer: Prime Health Services Commercial |
$19,005.15
|
|
|
HC IMPL SPINAL CANAL CATH
|
Facility
|
OP
|
$22,359.00
|
|
|
Service Code
|
CPT 62350
|
| Hospital Charge Code |
900100865
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$448.89 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$4,471.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$11,287.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16,930.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12,415.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,287.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$12,964.88
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$10,061.55
|
| Rate for Payer: Cash Price |
$10,061.55
|
| Rate for Payer: Cash Price |
$10,061.55
|
| Rate for Payer: Central Health Plan Commercial |
$17,887.20
|
| Rate for Payer: Cigna of CA HMO |
$14,309.76
|
| Rate for Payer: Cigna of CA PPO |
$16,545.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16,930.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,415.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11,287.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15,651.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,623.90
|
| Rate for Payer: EPIC Health Plan Senior |
$12,415.93
|
| Rate for Payer: Galaxy Health WC |
$19,005.15
|
| Rate for Payer: Global Benefits Group Commercial |
$13,415.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$20,123.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$18,511.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$448.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11,287.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14,197.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$495.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15,802.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,471.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15,124.86
|
| Rate for Payer: Multiplan Commercial |
$16,769.25
|
| Rate for Payer: Multiplan WC |
$12,964.88
|
| Rate for Payer: Networks By Design Commercial |
$14,533.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11,287.21
|
| Rate for Payer: Preferred Health Network WC |
$13,229.47
|
| Rate for Payer: Prime Health Services Commercial |
$19,005.15
|
| Rate for Payer: Prime Health Services Medicare |
$11,964.44
|
| Rate for Payer: Prime Health Services WC |
$12,832.59
|
| Rate for Payer: Riverside University Health System MISP |
$12,415.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13,415.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,179.50
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$11,287.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16,930.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,415.93
|
| Rate for Payer: Vantage Medical Group Senior |
$11,287.21
|
|
